What Is It?
Scaling and root planing is the most common
and conservative form of treatment for
periodontal (gum) disease. Scaling is the
removal of calculus (commonly called tartar)
and plaque that attach to the tooth
surfaces, especially below the gum line
along the root surface. Because plaque is
more likely to stick to rough surfaces, the
root surface is smoothed down in a process
called root planing. Root planing removes
any remaining calculus and smoothes
root-surface irregularities.

Plaque is a sticky substance, full of
bacteria, that usually forms on your teeth.
When plaque hardens over time, it is called
calculus.

What It's
Used For
Scaling and root planing are done to remove
the irritants (plaque and calculus) that can
cause periodontal disease. For early stages
of the disease, especially gingivitis, this
treatment may be all that is needed to get
the condition under control. With more
advanced gum disease, this may be the first
step before moving on to surgical treatment.

Preparation

For some patients, scaling and root planing
can cause discomfort. A local anesthetic may
be used to numb the portion of your mouth
that is being worked on.

How It's DoneScaling and root planing are done with a
combination of ultrasonic scalers and hand
instruments. Ultrasonic instruments are
electric or air-powered devices that have
two components: 1) a relatively dull metal
tip that vibrates at a very high frequency
and "knocks" plaque and calculus off the
tooth, and 2) a water irrigation system that
cools the tip and helps to flush out debris
from around the teeth. Hand instruments are
not powered. They have cutting edges and are
pressed against your teeth by your dentist
or hygienist. These instruments come in
various shapes and sizes. Different
instruments are used for different teeth,
and even for different surfaces of the same
tooth.

Typically, ultrasonic instruments are used
first to remove large deposits of plaque and
calculus from the crowns and roots of the
teeth. Hand instruments called scalers and
curettes then are used to remove any
remaining material and make sure that the
tooth surface is clean and smooth. When
working under the gum line, your dentist or
hygienist cannot see the plaque or calculus,
so he or she will rely on the sense of touch
to feel for roughness on the root surface.

If you have gingivitis (the earliest stage
of gum disease) or localized periodontitis
(more advanced gum disease located in only
one part of your mouth), scaling and root
planing usually can be completed in one
visit. However, if you have periodontitis
throughout your mouth, your periodontist
typically will do a quarter of your mouth (a
quadrant) at a time. This means that four
visits will be necessary to complete the
scaling and root planing.

Follow-UpFor two to three days after the
treatment, you may have some soreness and
sensitivity to hot and cold temperatures.
Over-the-counter pain relievers can relieve
this discomfort.

You may be asked to use an antispectic
mouthrinse after scaling and root planing,
especially when soreness of the gums
prevents effective oral hygiene measures.
However, brushing and flossing should be
continued as usual. Some minor bleeding can
be expected the first days after scaling and
root planing, but this usually stops within
a week.

RisksTreating periodontitis decreases gum
inflammation and also eliminates periodontal
pockets, which can trap plaque. Therefore,
if treatment is successful, your gums will
shrink or recede. The extent of shrinkage
depends on the initial depth of the pocket
and the severity of periodontitis. The more
severe the disease, the larger the recession
of the gums after successful therapy. As a
result, some part of the root is exposed,
making the tooth look longer and making it
more sensitive to hot and cold temperatures.
To prevent root cavities, your dentist may
prescribe a fluoride-containing gel, and
will emphasize the importance of good plaque
control.

If your medical doctor has told you that you
need to take antibiotics before certain
dental procedures, you should inform your
dentist or hygienist about this before you
undergo scaling and root planing.

When To Call A ProfessionalIf you develop a fever or experience
excessive bleeding, pain or swelling
following scaling and root planing you
should contact your dental professional.